Healthcare Provider Details

I. General information

NPI: 1962689919
Provider Name (Legal Business Name): ROBERT MARTIN NELSON D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2008
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

COBLESKILL DENTAL GROUP, PC 106 DIVISION ST.
COBLESKILL NY
12043
US

IV. Provider business mailing address

106 DIVISION ST.
COBLESKILL NY
12043
US

V. Phone/Fax

Practice location:
  • Phone: 518-234-4365
  • Fax:
Mailing address:
  • Phone: 518-234-4365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number053538
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: